Tapu Misa: Plenty of evidence that Maori miss out on healthcare

COMMENT

Leonard Pitts Jr, a columnist who writes for the Miami Herald, once commented that white Americans are forever complaining that blacks see everything in terms of race.

Impatient with the view that racism is at the root of every social ill afflicting African Americans - from poor health and early death to low educational achievement, disproportionately high crime rates and imprisonment - whites tend to deny that racism ever plays a part, even when the evidence is staring them in the face.

For blacks, says Pitts, it's always about race. For whites, it's never about race. The truth is probably somewhere in between.

I was reminded of this last week when Tariana Turia suggested during a Parliamentary debate that racism could be a factor in the bad health of Maori, and in the well-documented fact that Maori aren't getting the same access to healthcare as are Pakeha.

The Associate Minister of Health, who's been demonised by many Pakeha (and one or two Maori) since that Holocaust reference a while back, was loudly cried down by almost everyone on the opposition benches. It wasn't racism, retorted Winston Peters, but those too-frequent visits to KFC.

I'm not sure how they could all be quite so unequivocal, given the weight of international evidence pointing to at least some degree of institutional racism, but it does confirm an observation I've formed during the writing of this column: that the most efficient way to shut down a conversation is to utter the racism word.

Which is a shame, because if there's one discussion that requires sober assessment and calm analysis, then this is it.

In fact, Turia's remarks were positively restrained compared to those made by Dr Paparangi Reid, the director of the Wellington School of Medicine's Eru Pomare Maori health research centre, who said that Maori health was being stolen because people get a fast-track through the queue and they aren't brown people.

She should know. Dr Reid's researchers have evidence showing that Maori are less likely to be referred and less likely to have investigations from primary care through to secondary care.

In an interview in Mana Korero on National Radio, Dr Reid argued that social circumstances were a significant factor in Maori ill-health. An unfair proportion of resources is being misappropriated by Pakeha, she said, and that meant fewer jobs, more poorly paid work, worse housing and less education for Maori. All of which combined to put Maori under stress.

There's no disputing racial disparities in the health system. What is not so clear is why and what to do about it.

The lower life expectancies of Maori and Pacific people are well known now, thanks to studies done by Wellington and Christchurch Schools of Medicine (among others), but what isn't so widely known is that health outcomes are worse even when socio-economic status is taken into account.

Reid points to evidence which indicates, for example, that Maori men in the top occupational group have a higher death rate than non-Maori men in the bottom group.

There's a wealth of international evidence showing that racial minorities often get lower-quality health care than whites, even when they have similar incomes, age, and insurance coverage.

Last year the Institute of Medicine, an independent research institution that advises the United States Congress, released a comprehensive study of racial disparities in healthcare called Unequal Treatment. It found higher death rates among minorities from cancer, heart disease, diabetes and HIV infection.

Minorities were less likely to be given appropriate medications for heart disease, or to undergo bypass surgery, and were less likely to receive kidney dialysis or transplants than white people.

The authors said subtle, and in some cases subconscious, racial bias might be at work. While most health providers were well-intentioned, the study cited indirect evidence that doctors' decisions were influenced by their perceptions of race.

For instance, in New York state African Americans were 37 per cent less likely to undergo angioplasty and other heart procedures, including bypass surgery, than whites. In 90 per cent of the cases in which the patient did not get the surgery, the doctor had not recommended it.

Interviews with doctors brought out classic negative racial stereotypes, such as assumptions that black patients would be less likely to participate in follow-up care. Here, too, is evidence of unequal treatment.

A paper published in the New Zealand Medical Journal last April concluded that while Maori and Pacific people had higher rates of death from coronary artery disease, they were much less likely to have had life saving cardiac interventions, like bypass and angioplasty.

But is it racism? None of the studies provides absolute proof. What is clear is that this is a highly complex issue requiring much more research.

The Maori MP Dr Maui Pomare knew that back in 1901 when he launched a Maori health promotion programme. What was needed, he said, was leadership, action to relieve the socio-economic adversity faced by Maori, more skilled health workers, a recognition of the link between health and culture, and political commitment.

A century later and we still don't have it right.